J Korean Med Sci.  2017 Apr;32(4):621-627. 10.3346/jkms.2017.32.4.621.

Characteristics and Impact Factors of Renal Threshold for Glucose Excretion in Patients with Type 2 Diabetes Mellitus

• Yue XD
• Wang JY
• Zhang XR
• Yang JH
• Shan CY
• Zheng MY
• Ren HZ
• Zhang Y
• Yang SH
• Guo ZH
• Chang B
• Chang BC

• KMID: 2371447
• DOI: http://doi.org/10.3346/jkms.2017.32.4.621

Abstract

Sodium glucose co-transporter 2 (SGLT-2) inhibitors are newly developed but promising medicine for type 2 diabetes. However, patients with a different renal threshold for glucose excretion (RT(G)) may have a different reaction to this medicine. Therefore, the objective of this study was to investigate the characteristics of RT(G) and its impact factors in patients with type 2 diabetes mellitus (T2DM). The clinical and laboratory data of 36 healthy individuals and 168 in-hospital patients with T2DM were collected and analyzed, RTG was calculated using blood glucose (BG) measured by dynamic BG monitoring, urinary glucose excretion (UGE) and estimated glomerular filtration rate (eGFR). The characteristics of RT(G) were investigated. The risk factors for high RT(G) were analyzed using non-conditional logistic regression analysis. Our results found that RT(G) of the T2DM group was higher than that of the healthy individuals (P < 0.05); and 22.22% from the healthy individuals group but 58.33% from the T2DM group had high RT(G). Age, duration of diabetes, body mass index (BMI), and homeostasis model assessment insulin resistance index (HOMA-IR) were independently associated with high RT(G) (P < 0.05). Further stratified analysis revealed that RT(G) in T2DM patients increased with age, duration of diabetes, and BMI. In conclusion, RT(G) is increased in patients with T2DM, especially in those with longer diabetic duration, higher BMI, and those who are older. Therefore, these patients may be more sensitive to SGLT-2 inhibitors.

Keyword

Type 2 Diabetes Mellitus; Renal Threshold for Glucose Excretion; Risk Factor; Dynamic Blood Glucose Monitoring

Figure

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  Fig. 1 Comparison of RTG in T2DM patients with different age, BMI, diabetic duration, HOMA-IR or LDL-C. (A) Comparison of RTG among T2DM patients with different age (≤ 45, 46–59, ≥ 60 years). RTG was 178.89 ± 15.83, 190.34 ± 23.19, or 201.27 ± 27.78 mg/dL, respectively. (B) Comparison of RTG among T2DM patients with different diabetic duration (≤ 5, 6–9, ≥ 10 years). RTG was 182.61 ± 19.58, 189.62 ± 23.25, or 199.51 ± 23.51 mg/dL, respectively. (C) Comparison of RTG among T2DM patients with different BMI. RTG was 180.65 ± 18.97, 190.26 ± 24.97, or 208.75 ± 20.62 mg/dL, respectively. (D) Comparison of RTG among T2DM patients with different HOMA-IR. RTG was 184.39 ± 15.53, 195.64 ± 23.17, or 200.42 ± 24.94 mg/dL, respectively. (E) Comparison of RTG among T2DM patients with different LDL-C level RTG was 188.47 ± 20.51, 189.92 ± 23.20, or 190.58 ± 18.98 mg/dL, respectively. There was no statistical difference among the 3 groups (P > 0.05). RTG = renal threshold for glucose excretion, T2DM = type 2 diabetes mellitus, HOMA-IR = homeostasis model assessment insulin resistance index, LDL-C = low-density lipoprotein-cholesterol. *Significant difference (P < 0.05) was found in patients ≥ 60 years compared to the other groups; Trend test χ2 in Table 4 demonstrated that the RTG increased with age. †Significant difference (P < 0.05) was found between patient with diabetes duration ≥ 10 years and those with shorter duration; Trend test χ2 in Table 4 also demonstrated that the RTG increased with diabetes duration. ‡Significant difference (P < 0.05) was found between obese group and the other 2 groups; Trend test χ2 in Table 4 also showed that the RTG increased with BMI. §Significant difference (P < 0.05) was found between group with HOMA-IR ≥ 3 and the other groups; Trend test χ2 in Table 4 also showed that the RTG increased with HOMA-IR.

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